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EPA ID NUMBER CAL000143862 <br /> Page 2 of 6 <br /> III• RADIOACTIVE MATERIALS OR WASTE <br /> YES No <br /> — Does the facility use, store or treat radioactive taatenals or radioactive waste' <br /> n'. TYPE OF COMPANY: STANDARD LNDUSn At CLASSIFICATION (SIC) CODE: <br /> Use either one or two SIC codes (a four digit number) that best describe vour company's products. services. or industrial acovirv. <br /> Example: 7384 Photofinishing lab <br /> 7278 Industrial launderers <br /> Fust: 5912 RETAIL CHAIN DRUG <br /> Second: <br /> STORE <br /> V. PRIOR PERMIT STATUS: Check yes or no to each question: <br /> YES NO <br /> 1. Did you file a PBR Notice of Intent to Operate (DISC Form 8462) in 1992 for this location? <br /> Do you now have or have you ever held a state or federal hazardous waste facility frill permit or interim <br /> status for any of these treatment units? <br /> ® 3. Do you now have or have you ever held a state or federal full permit or interim status for any other <br /> hazardous waste activities at this location? <br /> ® 4. Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you <br /> are now notifying for at this location? <br /> ® 5. Has this location ever been inspected by the state or any local agency as a hazardous waste generator? <br /> VI. PRIOR ENFORCEMENT HISTORY: Nor required from conditionally exempt generators or commercial laundries. <br /> YES NO <br /> Withm the last three years, has this facility been the subject of anv convictions, judgments, settlements, or final <br /> orders resulting from an action by any local, state, or federal environmental, hazardous waStc, or public health <br /> enforcement agency? <br /> (For the purposes of this form, a nonce of violation does not constitute an order and need not be reported unless <br /> n was not corrected and became a final order.) <br /> If you answered Yes,.check this box and attach a listing of convictions,judgments•settlements. or orders and a copy <br /> of the cover sheet from each document. (See the Instructors for more information) <br /> NII. ATTACHMENTS: Attachments are not required from commercial laundries. <br /> X A plot planimap detailing the locauonis) of the covered unites) in relation to the facility boundaries. <br /> unit specific notification form for each unit to be covered at this location. <br /> DTSC 1772 (1;96) <br /> Page 2 <br />